Status of implementation of recommendations for section TB control in prisons
| Recommendations | Status | Implementation | Institution responsible for implementation | Deadlines |
| TB control in prisons | ||||
| General recommendations | ||||
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1. The financial resources for TB control in the State Department for the Enforcement ofSentences should be increased. Apart from ethical and equivalence issues, the current underfunding seriously contributes to the increased transmission of TB among detainees, personnel working in penal institutions and the population at large. |
Implemented
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| Special recommendations | ||||
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2. Case-finding based on symptoms arising during imprisonment should be strengthened. Staff should receive in-service training through cooperation and coordination with the Ministry of Health. |
Not implemented
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Identification of new and relapsing TB cases in the penitentiary system is still very poor in predetention centers and other penitentiary facilities, except for specialized TB facilities within the system. TB identification is mostly carried out with fluorography. Bacterioscopically identified cases are not reported by the penitentiary facilities despite the recommendations of the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis”. This issue is not solved with any regulations. Under the Global Fund grant, during 2011-2013, over 215 laboratory specialists, doctors and nursing staff of the penitentiary service were trained, who are involved in diagnosis and treatment of patients with sensitive and chemoresistant tuberculosis. |
The State Penitentiary Service of Ukraine
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On an ongoing basis |
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3. TB diagnoses should be strengthened, including the provision of rapid testing equipment and drug susceptibility testing. An increased budget and training of personnel are preconditions, as is the availability of all drugs to treat every case identified. |
Not implemented
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In 2012 and cohort 1-3 of 2013, TB diagnosis in the penitentiary service was on the level of 41%. Under the World Bank project titled “TB and HIV/AIDS control in Ukraine”, BACTEC TB mycobacterium analyzers, consumables and other laboratory equipment were supplied to some penitentiary TB hospitals. Under the Global Fund grant, during 2011-2013, over 215 laboratory specialists, doctors and nursing staff of the penitentiary service were trained, who are involved in diagnosis and treatment of patients with sensitive and chemoresistant tuberculosis. Since 01.07.2014 MDR-TB patients in the penitentiary facilities will be involved into treatment under the Global Fund grant. Ceaseless and full availability of anti-TB drugs for all patients in the penitentiary system has not been achieved. |
The State Penitentiary Service of Ukraine
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On an ongoing basis |
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4. The use of standard regimens for TB should be enforced. |
Implemented
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For prescription of treatment regimens, standardized regimens are applied in accordance with the unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Tuberculosis”. |
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5. An agreement should be made with the Ministry of Health that allows the pooling of anti-TB drugs procurement and savings of scale. |
Not implemented
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Agreement with the Ministry of Health of Ukraine on co-procurement of anti-TB drugs has not been concluded. It is impossible due to various budgets for the State Penitentiary System of Ukraine and the Ministry of Health of Ukraine. In accordance with the expert report drawn up in 2012 after the evaluation of needs of the State Penitentiary System of Ukraine for the resources intended to ensure effective TB fight at penitentiary and detention facilities, the patients failed to comply with full treatment regimens at the penitentiary facilities due to the lack of first-line and second-line drugs. |
The State Penitentiary Service of Ukraine
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6. Barriers to the continuation of treatment after release from prison should be removed by: (i) providing proper health education in prison; (ii) informing the Ministry of Health well in advance of a release from prison and allowing a Ministry of Health nurse or nongovernmental organization worker to visit the TB patient before release; (iii) allowing TB patients to receive treatment at the nearest health facility to their places of residence after release from prison, independently from their places of registration; (iv) not forcing exprisoners to register at police stations. |
Partially
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a) Under the project “Mobilization of Non-Governmental Organizations and Immediate Representatives of TB-Vulnerable Groups for Ensuring TB Prevention, Early Identification and Positive Attitude to Treatment”, since October 2011 the All-Ukrainian Charity Foundation “Coalition of HIV Service NGOs” has been ensuring the social escort of prisoners from penitentiary TB hospitals to a civilian sector in 8 regions of Ukraine (Zaporizhzhia, Mykolaiv, Poltava, Kherson, Dnipropetrovsk, Luhansk, Ternopil and Kharkiv regions), for the grant provided by the Global Fund. Effectiveness of this project in 2012 accounted for 63%, and in 2013 – 64% (percentage of former prisoners who were supported and who proceeded with TB treatment in a civilian sector). |
The State Penitentiary Service of Ukraine
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On an ongoing basis |
In accordance with the National Targeted Social Program on Combating Tuberculosis for 2012-2016, for the State Penitentiary Department it was planned to spend 22,405.56 ths. UAH for TB control in 2013 (for the purposes of comparison – this sum in 2012 totaled only 17,935.59 ths. UAH). In fact, financing (from various sources) in 2013 totaled 23,833.70 ths. UAH, which is a bit higher than it was planned. Financing is planned to be increased within the subsequent years of the Program implementation –27,979.06 ths. UAH for 2014 and 34,983.93 ths. UAH for 2015.